Provider Demographics
NPI:1124385505
Name:PASADENA FOOT AND ANKLE CENTER, LLC
Entity Type:Organization
Organization Name:PASADENA FOOT AND ANKLE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:PROEBSTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-761-3338
Mailing Address - Street 1:8023 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-7107
Mailing Address - Country:US
Mailing Address - Phone:410-761-3338
Mailing Address - Fax:410-761-0265
Practice Address - Street 1:8023 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-7107
Practice Address - Country:US
Practice Address - Phone:410-761-4190
Practice Address - Fax:410-761-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01059213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD243206Medicare PIN